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Naloxone reverses overdoses without hefty price tag

By Andrew M. Seaman

NEW YORK (Reuters Health) - Distributing a drug that reverses drug overdoses in heroin users would save lives and be cost-effective, according to a new analysis.

U.S. researchers, who published their findings in the Annals of Internal Medicine on Monday, calculated that one death may be prevented for every 164 naloxone injection kits they distribute to heroin users.

That, the researchers say, works out to be a few hundred dollars for every year of healthy life gained.

"The great news here is these overdose deaths can be prevented, it's cost effective to do so, and may even be cost saving," said Dr. Phillip Coffin, the study's lead author from the San Francisco Department of Public Health.

Naloxone is a drug that stops opioids such as heroin from reaching receptors in the brain, which may reverse an overdose. The drug is currently only approved by the U.S. Food and Drug Administration (FDA) to be injected into a person, but there are promising trials for an inhaled version of it.

The general idea, according to Coffin, is that giving heroin or opioid users naloxone injection kits gives them the chance to reverse another person's overdose.

"Typically when someone has an overdose, they're unconscious and they fall asleep quite quickly… So the idea that you would reverse your own overdose is not practical," said Dr. Wilson Compton from the National Institute on Drug Abuse (NIDA) in Bethesda, Maryland.

Currently, an estimated 213,000 people in the U.S. use heroin each year. Over that population's lifetime, more than one in 10 users may die of an overdose.

Compton, who co-authored an editorial accompanying the study, said naloxone has few side effects, except that high doses may send someone into withdrawal.

For the new study, Coffin and a colleague created a computer simulation that predicted what would happen if they distributed naloxone injection kits to 20 percent of U.S. heroin users, and compared the resulting deaths and costs to a simulation of users without kits.

In that scenario, the model found that in a population of 200,000 heroin users 6.5 percent of deaths that would have occurred could be prevented with distribution of the kits.

The simulation also found that almost 2 percent of heroin users eventually quit when the kits were distributed. That, however, also led to about a 1 percent increase in overdoses, because high-risk users were living longer.

The researchers calculated that the kits would cost about $400 for every year of healthy life gained.

That's well below the $50,000 per healthy year of life gained threshold that policymakers typically think is worth paying for, the authors note.

Coffin told Reuters Health that distributing the kits may end up saving money because it might prevent aggressive attempts to revive a person who overdoses, which can be costly.

"This study helps us understand that providing naloxone is not only effective, but can also be a very cost effective approach to preventing overdose deaths in heroin addicts," Compton said.

Coffin added that there may be additional benefits from distributing the kits based on real-world experiences in places such as New York City, Chicago, San Francisco and Scotland, where overdose deaths fell between 37 percent and 90 percent with naloxone distribution programs.

"It may be influencing behavior," said Coffin. "That rides on the assumption that talking to people about overdoes and providing them with a tool to prevent overdoses makes them a little bit more careful."

But Compton said these kits may only be part of an approach to curb the growing epidemic of opioid overdose deaths.

"Providing this intervention to address the overdose epidemic is one piece of it, but we think it must be part of a larger approach to prevent the abuse and misuse of prescription drugs," he said.

According to Compton and his editorial co-authors, which include NIDA Director Dr. Nora Volkow and representatives from the FDA, total U.S. drug overdose deaths in 2010 reached almost 40,000 and outpaced deaths from motor vehicle accidents.

Overall, Coffin told Reuters Health he thinks the results are "fantastic," because it shows "it's a really excellent benefit for a modest amount of dollars."

SOURCE: http://bit.ly/Ms1ZbQ Annals of Internal Medicine, online December 31, 2012.

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